This year has seen a surge of interest from services wanting to be awarded the OH sector standard. Nic Paton looks at the impact of SEQOHS on quality and where it may go next.
To gain a sense of the momentum building behind SEQOHS, the OH accreditation programme launched in 2010, you need only to read a press release issued by the Faculty of Occupational Medicine (FOM) last December.
This revealed that the Safe Effective Quality Occupational Health Service programme, to give it its full name, managed by the Royal College of Physicians on behalf of the faculty, had in October reached the one million mark in the number of employees accessing OH services through SEQOHS-accredited providers.
Scroll forward to March this year, and already that figure was what you could reasonably call old news.
Dr Sally Coomber, clinical lead for SEQOHS and director of Suffolk Occupational Health for the Ipswich Hospital NHS Trust, said: “We have reached a number of milestones as the scheme has matured. We now have five million employees in England, Scotland, Wales and Northern Ireland, and we have just extended into the Republic of Ireland, too. From June, we expect to have full coverage of the British Isles.”
SEQOHS is not for everybody, but I do hope that – in time – it will become the norm.”
Dr Sally Coomber,
With huge providers such as Atos Healthcare now accredited as well as small players at the other end of the spectrum (see <A href="#case-study-one" case study 1and case study 2), SEQOHS is becoming an increasingly familiar part of the landscape for OH practitioners, something that, while not compulsory to have, is increasingly needed to maintain commercial competitiveness.
“SEQOHS is not for everybody,” says Coomber. “Not every organisation is going to be ready to go through this much internal work. But I do hope that, in time, it will become the norm – it is now definitely starting to appear in tendering documents in some areas. But I do not envisage that it will ever become compulsory.”
Darran Cahill, SEQOHS manager, says that some 70 organisations now have the “kitemark” and adds: “Since January we have seen a real surge in services becoming ready to be accredited.
“And there’s a wide range – from single-handed practitioners to big in-house providers. Most of the larger providers have by now gone through, as have quite a lot of the NHS services; about 60% of the accredited services are NHS ones.”
The great value of SEQOHS is that it has provided – and is continuing to provide – a standard to help employers identify providers that are competent and capable of delivering quality OH services, says Dr Richard Heron, president of the Society of Occupational Medicine.
“SEQOHS has been a fantastic way of raising the level of quality that is required by employers. It is non-compulsory – but if you do not have it, you potentially put yourself at a commercial disadvantage to a provider that does have it,” he adds.
For practitioners who are yet to go through the process, or are preparing to, the message is very much that it is important to recognise that a considerable degree of work and commitment will be involved.
“One of the things we have learned is that people need to understand what accreditation is about,” says Coomber. “They need to understand why they are going through it and be mentally committed to continuous improvement. It needs to become the ‘normal’ way of practising and of sharing best practice.
“It does involve an investment of time and energy; you cannot just print off some policies and put your name at the top of them. But at the same time there are now a lot of examples of how people have done it and what they have done, so organisations should not have to reinvent the wheel every time. There is a lot of reassurance in terms of the evidence that is now available and uploaded for people to share.”
SEQOHS has been a fantastic way of raising the level of quality that is required by employers.”
Dr Richard Heron, Society of Occupational Medicine
It is a good idea to speak to people who have been through the process already, says Helen Kirk, managing consultant of consultancy HK Consulting, who works as an assessor and last year supported Cheshire Occupational Health Service at Mid Cheshire Hospital NHS Foundation Trust through accreditation. It is also sensible to make full use of the resources on the SEQOHS website.
“Isolated evidence is never enough,” she says. “It is how it is validated. Like any other audit there will be different layers to it. You need to treat it like a systematic audit involving as many people in the organisation as possible.”
Hilary Winch, an occupational health nurse manager at Norfolk & Norwich University Hospital NHS Trust, whose unit was accredited just over a year ago, and like Kirk is an assessor for the programme, agrees.
“OH units definitely need to put some effort into it in order to achieve accreditation,” she says. “Within our unit, we had one person coordinating it – me – and we started very simply by doing a gap analysis, so looking at what evidence was required, what we already had and what we needed to work on.
“Fortunately, we had a lot of evidence available to us from the trust, but it was still a question of making sure we had the relevant documents to hand and that we had undertaken the practical aspects of these documents. Having someone tasked with coordinating it all is important. For example, we had a range of operating procedures that we needed to look at to make sure they were up to date and aligned with best practice. It is also important you embark on clinical audit.
“It is not an overnight job. It also needs to become embedded within your unit’s culture – for some units, it may be a real culture change. It is hard work, but we can now see the improvements in our practice as a unit; we were already doing a lot of it, but the process made us step back and formalise it.”
Conflict of interest
A key concern among many practitioners when SEQOHS was launched was who would be assessing their unit, and especially whether there would be any commercial conflict of interest as a result. At the time, SEQOHS moved quickly to reassure practitioners that they would be able to ask for a different assessor if there was any concern, and this has become a valued element of the process, says Winch.
“We refused our first assessor because we felt there was a potential conflict of interest, even though we knew they had signed confidentiality clauses,” she says.
“But changing assessor was absolutely fine. As an assessor myself, you have to read a massive amount of information, so you are not going to take notice of prices or customers anyway.”
As with any accreditation, SEQOHS demonstrates a commitment to quality, which I strongly believe is an essential element of occupational health.”
Jane Fairburn, executive director of PAM OH Solutions, who also works as an assessor, says that it is important not to devolve the process: “Make sure it’s owned by a key stakeholder and fully supported by everyone. Keep people informed of what you need and by when. The standard forces an annual formal audit of the service, which is always going to be a helpful measure in any organisation. There are commercial benefits, and this is likely to remain the case. As with any accreditation, SEQOHS demonstrates a commitment to quality, which I strongly believe is an essential element of OH.”
PAM OH Solutions was the first provider to complete the annual reaccreditation process. Fairburn says that it is important to understand that SEQOHS is not just a one-off process.
So where does SEQOHS go next? As Coomber points out, the next stage is an important review process, with a conference probably in 2014/15. The FOM is also working to develop a “map” of the type of OH services available in the UK, something that could provide a very valuable picture of OH provision across the country.
“We need to make sure SEQOHS remains fit for purpose and look at any wording that has become uneven or different,” Coomber says. “It will now be about taking it to a level where it is more accessible to single-handed practitioners; we will need to think carefully about what is needed to demonstrate standards for these practitioners.”
Potential for growth
The review process is going to be important to ensure SEQOHS remains relevant and continues to evolve to meet the needs of the working population, says Fairburn.
“The next stage is for the procurers to understand what the standard means and then to ensure key performance indicators reflect the requirements and are used as a measure of the provision,” she says.
The Society of Occupational Medicine’s Heron, for one, believes there is potential for SEQOHS to go even further in time, describing the current programme as, in essence, “entry level”.
He says: “I would like to see it going on to another level – I think there is a real opportunity for the faculty and those leading SEQOHS to create perhaps a ‘SEQOHS plus’ for those organisations that want to highlight to a further level what their services can do.”
The detail of what this might include would, of course, need to be discussed further, but Heron suggests that SEQOHS accreditation could, in time, become a vehicle for demonstrating excellence in culture, behaviours and attitudes as well as pure delivery of service.
“It is not just what is in the service that is important, it is how that service is being delivered,” he says.
With just two full-time occupational health nurses, Bridgend-based Workare Ltd is one of the smallest providers to have secured SEQOHS accreditation, which it achieved in February.
“We work mainly with the private sector, although we do have a contract with the Welsh Government, which we only won in December, so being SEQOHS-accredited is really good in terms of kudos. It has raised our profile no end,” says managing director Lorainne Jenkins.
“There are a lot of OH companies, especially small sole traders, masquerading as something they are not, and it can be very difficult for clients to distinguish what is a good trader and what is not. So being able to show you have a recognised quality mark is important. It is also useful as something to benchmark ourselves against.
“Even though we are small we are well run – for example, we have been accredited with Investors in People for the past 15 years. So a lot of our procedures and processes were up to date already, which helped.
“You have to be very well organised. If you have been through the audit process before, that helps. For a small company, especially if you have nothing in place beforehand, it can be an awful lot of work. The challenge is that, as a process, it has really been designed for larger organisations.
“My assessors were not really sure what to expect, and so we had to have all the policies and procedures in place, even though there are only two of us.
“What it does is make you focus on things that are often overlooked, such as regular audit. Just going through the process has been helpful.
“We make sure 10% of our records are now audited monthly so when reaccreditation comes around again in a few years’ time it should be easier.”
Atos Healthcare is one of the UK’s largest providers of OH services, delivering solutions from 150 sites to more than one million employees each year. It employs about 200 clinicians and between 200 and 250 administrative staff. With such large numbers of people involved, there was little debate as to whether the company needed to secure SEQOHS accreditation, says chief medical officer Dr Lucy Wright.
“There is a dearth of quality standards for OH so, for us, market speaking, it was clearly foolish not to be doing this,” she explains.
“A lot of tenders now specify that a provider needs to be SEQOHS accredited or, at the very least, working towards it. As a large provider, it is expected of us.”
The company achieved accreditation in November last year, but it was the culmination of an intensive six-month process, says Wright.
“For an organisation of our size, it is not something that can be done quickly. We had someone working on it full time for six months. Because everything has to be evidenced, there is a lot of paperwork that has to be put together,” she says. “There can also be a lot of background evidence that is required – so if, for example, you say, as we do, that we look after a million employees, you need to be able to show that.
“I’d advise speaking to the assessor when you get started about what they will be expecting to ensure that you are not wasting time gathering information that will not be needed. You need to be clear on what they are looking for and what evidence will be accepted. You also, of course, need to make sure you are ticking all the boxes required.”
However, she warns: “You do need someone coordinating it, even if just purely from a diary perspective. If, for example, you have an assessor going to different locations, you need to be sure the right people are going to be there for them to speak to.
“It is very, very thorough, but it is also a very useful exercise in itself to go through because it forces you to look at your company and how you are operating.”
She adds: “Often, it can be all too easy to become caught up in the day-to-day minutiae, but this makes you step back and ask: ‘How do we do this?’ We found it an exceptionally good experience.”